Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three stage... more Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P ho...
Background: Infants are subjected to painful procedures as part of routine care. Evidence suggest... more Background: Infants are subjected to painful procedures as part of routine care. Evidence suggests human milk (HM) has pain-relieving qualities; however, nurses may not be aware of this evidence. Purpose: This article presents the evidence for HM and breastfeeding for pain management, as well as describes using the evidence to create an interprofessional enterprise-wide policy on the topic. Methods/Search Strategy: Cochrane, PubMed, CINAHL, and Medline were searched for full-length articles published in peer-reviewed journals between 2012 and 2020. Articles using HM as an independent variable during a painful procedure, or discussing benefits of HM for pain management, were analyzed. Findings/Results: Ten articles were selected for evaluating use of HM for pain relief in term and preterm infants. There is statistically significant evidence that expressed HM has pain-relieving abilities, especially when combined with other soothing interventions such as rocking. HM reduces crying tim...
The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices ... more The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to ...
MCN: The American Journal of Maternal/Child Nursing
Creating a supportive environment for breastfeeding mothers in the primary care setting has been ... more Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians,...
Behavioral Health Services with High-Risk Infants and Families
The use of human milk and breastfeeding is a lifesaving medical intervention for infants who are ... more The use of human milk and breastfeeding is a lifesaving medical intervention for infants who are cared for in intensive care units at birth. Despite modest increases in breastfeeding initiation rates in the United States, exclusive human milk rates at 6 months continue to be only approximately 25%. Health care providers must be aware of disparities in breastfeeding rates with many low-income groups and persons of color. The Spatz 10-step model for human milk and breastfeeding in vulnerable infants has been implemented throughout the United States and the world. Key components include, but are not limited to, informed decision-making, establishment and maintenance of milk supply, oral care and feeding of human milk, preparation for discharge, and appropriate follow-up. Breastfeeding has been reported to positively impact mood and stress reactivity, and it can help facilitate maternal sensitivity and secure attachment between mother and infant compared to formula feeding. In this chap...
BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associa... more BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associated with longer duration of B/LPOM use for infant feedings in healthy term and hospitalized preterm infants. This relationship has not been explored in infants undergoing neonatal surgery (surgical infants). PURPOSE To evaluate the relationship between early exclusive B/LPOM feeds and cumulative B/LPOM patterns during surgical infants' neonatal intensive care unit (NICU) hospitalization. METHODS A secondary cross-sectional analysis was performed using the electronic health record data of surgical infants admitted to a level IV NICU between January 2014 and March 2015. Multiple linear regression and Fisher's exact test were used to examine the associations between first NICU feed type and total percentage of diet composed of B/LPOM during NICU stay and continuation of any or exclusive B/LPOM feedings at NICU discharge, respectively. RESULTS The analysis included 59 infants who required surgery for gastrointestinal, cardiac, or multisystem defects or pregnancy-related complications. Receipt of B/LPOM as the first NICU feed was associated with higher percentage of B/LPOM feeds (P < .001) throughout NICU stay, as well as continuation of any or exclusive B/LPOM feedings at NICU discharge (P = .03). IMPLICATIONS FOR PRACTICE Early exclusive B/LPOM feeds may be an important predictor for continuation of any B/LPOM use throughout the NICU stay and at NICU discharge. Continued efforts to identify and address gaps in prenatal and postpartum lactation support for parents of surgical infants are needed. IMPLICATIONS FOR RESEARCH Powered studies are needed to corroborate these findings and to explore the potential impact of other factors on duration and exclusivity of B/LPOM use. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Although the rate of breastfeeding initiation in the United States has continued to rise since 19... more Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future succe...
Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, ... more Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.
Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was t... more Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was to assess breastfeeding intentions and knowledge among women participating in doula-facilitated prenatal education classes from August 2016 to October 2017. Breastfeeding knowledge and infant feeding intentions were assessed before and after the classes. Breastfeeding rates were assessed at birth, 2-4 weeks postpartum, and 6-8 weeks postpartum. Paired t-tests tests were conducted. A total of 121 racially diverse, low-income women were enrolled. Intentions to breastfeed increased pre- to post-intervention (p = 0.007). Breastfeeding knowledge scores increased pre- to post-intervention (p <.001); specifically, among women who were exclusively breastfeeding or breastfeeding while supplementing with formula at birth (p < .001 and p = 0.046, respectively). Doula-facilitated breastfeeding education may help improve breastfeeding outcomes for low-income women.
Research examining needs of postpartum transgender men in relation to lactation and infant feedin... more Research examining needs of postpartum transgender men in relation to lactation and infant feeding is missing from nursing literature. Accordingly, little is known about how perinatal nurses can best support this unique subset of postpartum patients. Case studies presented here reveal that transgender men would appreciate care from nurses who are knowledgeable about transgender individuals and their healthcare needs, but this type of care is not always available. Nurses need more education about how to best support transgender patients and families in order to achieve optimal lactation and infant nutrition in this
The process of human milk donation and sharing for the promotion of infant health is a phenomenon... more The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.
Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three stage... more Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P ho...
Background: Infants are subjected to painful procedures as part of routine care. Evidence suggest... more Background: Infants are subjected to painful procedures as part of routine care. Evidence suggests human milk (HM) has pain-relieving qualities; however, nurses may not be aware of this evidence. Purpose: This article presents the evidence for HM and breastfeeding for pain management, as well as describes using the evidence to create an interprofessional enterprise-wide policy on the topic. Methods/Search Strategy: Cochrane, PubMed, CINAHL, and Medline were searched for full-length articles published in peer-reviewed journals between 2012 and 2020. Articles using HM as an independent variable during a painful procedure, or discussing benefits of HM for pain management, were analyzed. Findings/Results: Ten articles were selected for evaluating use of HM for pain relief in term and preterm infants. There is statistically significant evidence that expressed HM has pain-relieving abilities, especially when combined with other soothing interventions such as rocking. HM reduces crying tim...
The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices ... more The COVID-19 pandemic has impacted breastfeeding and lactation globally, with clinical practices implemented early in the pandemic being mostly anti-breastfeeding, e.g., separation of mothers from their infants, and not evidence based. As the pandemic has progressed, evidence has emerged reconfirming the value of human milk and the importance of protecting and supporting breastfeeding, especially the initiation of lactation. However, it is clear that COVID-19 has changed the clinical care paradigm around breastfeeding and lactation support and, as such, it is imperative that practices adapt and evolve to maintain the emphasis on lactation support. We participated in a round table conference aiming to rescue and develop protocols and practices that support breastfeeding during the COVID-19 pandemic. One key area to target will be to maximize the use of the antenatal period. The early identification of lactation risk factors together with the development of person-centered methods to ...
MCN: The American Journal of Maternal/Child Nursing
Creating a supportive environment for breastfeeding mothers in the primary care setting has been ... more Creating a supportive environment for breastfeeding mothers in the primary care setting has been shown to improve breastfeeding rates and duration. An important aspect of establishing a breastfeeding-friendly practice is to engage and educate health care providers. To increase consistency of breastfeeding care and interventions across a large primary care network, we established an Ambulatory Breastfeeding Consortium (ABC) focused on information sharing and discussion centered on care of breastfeeding and lactating families. The COVID-19 pandemic further highlighted the need to share up-to-date education and guidance, and the importance of the role of primary care providers in breastfeeding support. The ABC has been effective in engaging primary care nurses and other clinicians and disseminating information while encouraging discussion on the importance of providing informed care to breastfeeding families. Although more breastfeeding-specific education is recommended for clinicians,...
Behavioral Health Services with High-Risk Infants and Families
The use of human milk and breastfeeding is a lifesaving medical intervention for infants who are ... more The use of human milk and breastfeeding is a lifesaving medical intervention for infants who are cared for in intensive care units at birth. Despite modest increases in breastfeeding initiation rates in the United States, exclusive human milk rates at 6 months continue to be only approximately 25%. Health care providers must be aware of disparities in breastfeeding rates with many low-income groups and persons of color. The Spatz 10-step model for human milk and breastfeeding in vulnerable infants has been implemented throughout the United States and the world. Key components include, but are not limited to, informed decision-making, establishment and maintenance of milk supply, oral care and feeding of human milk, preparation for discharge, and appropriate follow-up. Breastfeeding has been reported to positively impact mood and stress reactivity, and it can help facilitate maternal sensitivity and secure attachment between mother and infant compared to formula feeding. In this chap...
BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associa... more BACKGROUND Early exclusive birth/lactating parent's own milk (B/LPOM) feeds have been associated with longer duration of B/LPOM use for infant feedings in healthy term and hospitalized preterm infants. This relationship has not been explored in infants undergoing neonatal surgery (surgical infants). PURPOSE To evaluate the relationship between early exclusive B/LPOM feeds and cumulative B/LPOM patterns during surgical infants' neonatal intensive care unit (NICU) hospitalization. METHODS A secondary cross-sectional analysis was performed using the electronic health record data of surgical infants admitted to a level IV NICU between January 2014 and March 2015. Multiple linear regression and Fisher's exact test were used to examine the associations between first NICU feed type and total percentage of diet composed of B/LPOM during NICU stay and continuation of any or exclusive B/LPOM feedings at NICU discharge, respectively. RESULTS The analysis included 59 infants who required surgery for gastrointestinal, cardiac, or multisystem defects or pregnancy-related complications. Receipt of B/LPOM as the first NICU feed was associated with higher percentage of B/LPOM feeds (P < .001) throughout NICU stay, as well as continuation of any or exclusive B/LPOM feedings at NICU discharge (P = .03). IMPLICATIONS FOR PRACTICE Early exclusive B/LPOM feeds may be an important predictor for continuation of any B/LPOM use throughout the NICU stay and at NICU discharge. Continued efforts to identify and address gaps in prenatal and postpartum lactation support for parents of surgical infants are needed. IMPLICATIONS FOR RESEARCH Powered studies are needed to corroborate these findings and to explore the potential impact of other factors on duration and exclusivity of B/LPOM use. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.
Although the rate of breastfeeding initiation in the United States has continued to rise since 19... more Although the rate of breastfeeding initiation in the United States has continued to rise since 1972, African American mothers continue to experience a significant disparity in initiation. The aim of this study was to explore the perceptions of the facilitators and barriers of breastfeeding initiation among African American mothers from the perspective of subject matter experts (SMEs). This study was part of a larger study that also involved focus group methodology with African American women. The purpose of this article is to describe the opinions, knowledge, and perceptions of SMEs who work with African American mothers. A semistructured interview guide was used to interview 7 SMEs at which point no new themes emerged from the data. SMEs highlighted the significance of modifiable factors in breastfeeding initiation decisions and validated many perceptions of African American mothers. SMEs identified many critical issues foundational to community perspective and shaping future succe...
Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, ... more Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.
Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was t... more Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was to assess breastfeeding intentions and knowledge among women participating in doula-facilitated prenatal education classes from August 2016 to October 2017. Breastfeeding knowledge and infant feeding intentions were assessed before and after the classes. Breastfeeding rates were assessed at birth, 2-4 weeks postpartum, and 6-8 weeks postpartum. Paired t-tests tests were conducted. A total of 121 racially diverse, low-income women were enrolled. Intentions to breastfeed increased pre- to post-intervention (p = 0.007). Breastfeeding knowledge scores increased pre- to post-intervention (p <.001); specifically, among women who were exclusively breastfeeding or breastfeeding while supplementing with formula at birth (p < .001 and p = 0.046, respectively). Doula-facilitated breastfeeding education may help improve breastfeeding outcomes for low-income women.
Research examining needs of postpartum transgender men in relation to lactation and infant feedin... more Research examining needs of postpartum transgender men in relation to lactation and infant feeding is missing from nursing literature. Accordingly, little is known about how perinatal nurses can best support this unique subset of postpartum patients. Case studies presented here reveal that transgender men would appreciate care from nurses who are knowledgeable about transgender individuals and their healthcare needs, but this type of care is not always available. Nurses need more education about how to best support transgender patients and families in order to achieve optimal lactation and infant nutrition in this
The process of human milk donation and sharing for the promotion of infant health is a phenomenon... more The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.
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Papers by Diane Spatz